BILL ANALYSIS Ó SB 1045 Page 1 SENATE THIRD READING SB 1045 (Beall) As Amended June 15, 2014 Majority vote SENATE VOTE :35-0 HEALTH 17-0 ----------------------------------------------------------------- |Ayes:|Pan, Maienschein, | | | | |Ammiano, Bonilla, Bonta, | | | | |Chesbro, Gomez, Roger | | | | |Hernández, Lowenthal, | | | | |Mansoor, Nazarian, | | | | |Nestande, Patterson, | | | | |Ridley-Thomas, Rodriguez, | | | | |Wagner, Wieckowski | | | | | | | | ----------------------------------------------------------------- SUMMARY : Changes the number of individuals allowed in a group to a minimum of two and a maximum of 14 for outpatient drug free services for the purposes of Drug Medi-Cal (DMC) reimbursement and requires at least one individual in the group to be a Medi-Cal eligible beneficiary; for groups consisting of two individuals, the individual that is not a Medi-Cal eligible beneficiary must be receiving outpatient drug free services for a diagnosed substance abuse disorder. EXISTING LAW : 1)Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care services. 2)Establishes the DMC program, which provides substance use disorder services to Medi-Cal recipients. 3)Allows DHCS to enter into contracts with counties for the provision of DMC services. If a county declines to contract with DHCS, existing law requires DHCS to contract for services in the county to ensure beneficiary access. 4)Requires each county to fund the nonfederal share for DMC SB 1045 Page 2 services through realignment funds, as specified. 5)Requires providers of DMC services to obtain certification from DHCS to provide those services. 6)Requires a group for outpatient drug free services and narcotic treatment programs to consist of a minimum of four and a maximum of 10 individuals, of which at least one must be a Medi-Cal-eligible beneficiary. FISCAL EFFECT : None COMMENTS : According to the author, even though DMC treatment services have been expanded, many counties find it difficult to offer these benefits due to state restrictions, such as the limitation on group size for outpatient treatment (counseling services). Current state law specifies that outpatient counseling groups must have between four and 10 participants in order for the program to bill for and receive Medi-Cal reimbursement. The author further states that this restriction poses a problem for both small and large population counties. Small population rural counties, in which program participants may have to travel long distances to attend group counseling sessions, often have trouble getting four or more people together for a group, but if they have less than four participants, they cannot receive Medi-Cal reimbursement for that counseling session. Large population counties have the opposite problem. According to the author, when more than 10 people show up for a group session, a common occurrence, some participants may have to be excluded, otherwise the county cannot bill Medi-Cal for any of the services provided to the Medi-Cal-eligible participants. Thus, the group size restriction presents a significant barrier to effective treatment. Alcohol and other drug use disorders are substantial public health problems, affecting approximately 10% of the population and resulting in economic costs to the nation of around $360 billion annually, with roughly half of this amount attributable to alcohol use disorders (Office of National Drug Control Policy 2004). According to the National Institute on Drug Abuse, in 2011, 21.6 million people aged 12 years or older needed treatment for an illicit drug or alcohol use problem, but only SB 1045 Page 3 2.3 million received treatment at a specialty substance abuse facility. Mental Health America of California and the California Council of Community Mental Health Agencies, write that this bill creates more flexibility in group outpatient drug free services under the DMC program by decreasing the minimum size from four to two and increasing the maximum size from 10 to 14. They argue that given the shortage of facilities and low reimbursement rates that create a significant access problem, this bill helps address that problem. This bill has no opposition. Analysis Prepared by : Paula Villescaz / HEALTH / (916) 319-2097 FN: 0003943